炎性肠病45例手术治疗及疗效评价

Evaluation of therapeutic effects and surgical treatments of 45 cases of inflammatory bowel disease

目的探讨炎性肠病的手术治疗方法及疗效评估。方法回顾性分析近6年经外科手术治疗的45例炎性肠病患者的临床资料。结果急诊手术16例，Crohn病9例，溃疡性结肠炎（UC）7例。择期手术29例，Crohn病4例，UC25例。其中13例Crohn病患者行小肠部分切除6例，内瘘者行小肠及结肠部分切除、吻合术1例，回肠穿孔修补术1例，腹腔镜下小肠部分切除5例。32例UC患者中，行全结肠、部分直肠切除、直肠黏膜剥除、回肠贮袋肛管手法吻合术（IPAA）手术25例，全结肠直肠切除回肠造口术3例，行单纯回肠造口术4例。治愈27例，好转14例，死亡4例。结论炎性肠病临床表现多种多样，采用相应的手术方式是手术成功的关键。

Objective To elucidate the evaluation of therapeutic effects and surgical treatments of 45 cases of inflammatory bowel disease. Methods Clinical data of 45 cases with inflammatory bowel disease by surgical treatment in recent 6 years were retrospectively analyzed. Results Patients received emergency operation in 16 cases, Crohn＇ s disease in 9 cases, Ulcerative Colitis（UC） in 7 cases. Among 13 cases of Crohn＇ s disease, partial enterectomy occured in 6 cases, partial enterectomy and colectomy and anastomosis in 1 patient because of internal fistula, repair of ileal perforation in 1 case, laparoscopic ileocolic resection in 5 cases. Among 32 eases of UC, 25 cases underwent ileal pouch-anal anastomosis operation, 3 cases underwent ileostomy with total colectomy, and 4 eases only underwent ileostomy. Twenty-seven cases were cured by operation, 14 cases were improved and 4 cases died. Conclusion It is the key point to achieve successful operation that the corresponding operative modes for varied manifestations of inflammatory bowel disease should be adopted.